November 14, 2018
Today’s Top Story

Study: Meniscal Repair Produces Similar Failure Rates in Younger and Older Patients

A systematic review published online in The Knee found that age may not impact clinical postoperative success rates following meniscal tear repair. Researchers assessed studies that reported either individual patient data that included at least one patient aged 40 years or older or summary data with all patients aged 40 years or older. Previously reported risk factors, including anterior cruciate ligament reconstruction, tear location, and tear pattern, were used to determine failure rates. The final analysis included data on 148 patients (125 inside-out repairs and 23 all-inside repairs) from 11 studies. The overall failure rate was 10 percent (n = 15) and ranged from 0 percent to 23 percent in individual studies with more than one patient aged 40 years or older. Most tears were peripheral, either with or without avascular extension, both of which had a 9 percent overall failure rate. When tear pattern data were available, overall failure rates were 9 percent for vertical-longitudinal or bucket handle tears, and 23 percent for complex and/or horizontal tears.

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Other News

Study Identifies Predictors for Inpatient Status in Medicare THA Patients

In a study published online in The Journal of Arthroplasty, researchers sought to identify possible indicators of total hip arthroplasty (THA) patients eligible for outpatient treatment. Primary THA patients aged older than 65 years who underwent surgery between 2006 and 2015 were identified using the American College of Surgeons National Surgical Quality Improvement Program database. Inpatient stay was defined as a stay exceeding two days. Researchers gathered data for 30,587 inpatient THAs and 17,024 outpatient THAs. The greatest determinants of inpatient status were heart failure, simultaneous bilateral THA, age older than 80 years, female sex, and dependent functional status.

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Study: Efficacy of Arthroscopic Double-layer Lasso Loop Technique for Delaminated Posterosuperior Rotator Cuff Tear Repair

According to a study published online in Arthroscopy, the arthroscopic double-layer lasso loop repair technique is an effective treatment with a low rerupture rate for delaminated posterosuperior rotator cuff tears. Researchers evaluated pre- and postoperative clinical and functional scores in 32 patients who underwent arthroscopic rotator cuff repair of a delaminated posterosuperior rotator cuff tear by the double-layer lasso loop technique. Patients who underwent prior shoulder surgery were excluded. At mean 44-month follow-up, patients experienced significant improvements in their postoperative Constant score (54 versus 83) and University of California, Los Angeles functional score (6.4 versus 95). The Jobe test, bear-hug test, belly-press test, Gerber lift-off test, and external rotation test all showed improvements in pain and strength. Strength differences did not significantly differ on operated and nonoperated sides. One patient had a complete rupture and five had partial ruptures.

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Study: STAR Prosthesis Survival Rates in TAA Patients

Use of the Scandinavian Total Ankle Replacement (STAR) prosthesis in total ankle arthroplasty (TAA) patients was associated with good survival rates in a study published online in Foot & Ankle International. The study involved 131 patients (50 males, 81 females; mean age, 61.5 years) who underwent 138 STAR TAAs performed by a single surgeon between 1999 and 2013. Mean follow-up for patients who survived and retained both initial components throughout the study period was 8.8 years. Between preoperative assessment and final follow-up, the mean change in American Academy of Orthopaedic Foot and Ankle Surgeons Ankle-Hindfoot Scale scores was 36. Twenty-one (15.2 percent) implant failures occurred at a mean 4.9 years postoperatively. After an average 8.9 years after surgery, 10 polyethylene components in nine TAAs (6.5 percent) required replacement due to fracture. Fourteen patients died with their initial implants.

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Study: Sagittal Diameter and Translation Impact on SCI

Facet dislocation patients with greater translation and/or a smaller canal diameter at the injury level have higher spinal cord injury (SCI) rates, according to a study published online in The Spine Journal. Researchers collected data on demographics, neurologic exams, and radiographic findings for 97 facet dislocation patients treated at a Level I trauma center between 2004 and 2014. More than half (n = 59, 61 percent) had an SCI. American Spinal Injury Association (ASIA) Impairment Scale grade A patients had an average 8 mm of injury level canal diameter, and ASIA grade E patients averaged 12.6 mm. For translation, ASIA grade A averaged 8 mm, and ASIA grade E had a mean 4.2 mm. Patients were classified by general motor function: ASIA grade A–C and ASIA grade D–E. ASIA grade A–C patients had a mean 8.4 mm of injury level canal diameter compared to 12.3 mm for ASIA grade D–E. ASIA grade A–C and D–E averaged 7.8 mm and 4.4 mm of translation, respectively. Translation was indicative of ASIA grade A–C, while canal diameter predicted ASIA grade D–E.

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Study Probes Effect of Tibial Component Positioning in Ankle Arthroplasty

Compared to THA and total knee arthroplasty (TKA), TAA is still a relatively new procedure. A recent study investigated the effects of TAA design and implant position on ankle mechanics. Constantine Demetracopoulos, MD, of Hospital for Special Surgery in New York, presented the findings at the American Orthopaedic Foot & Ankle Society Annual Meeting. The study authors concluded that more research needs to be done to accurately assess the effects of design and implant position.

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AAOS Statement on Potentially Misvalued Codes in 2019 Medicare Physician Fee Schedule

AAOS President David A. Halsey, MD, issued a statement in response to the Centers for Medicare & Medicaid Services (CMS) identifying potentially misvalued current procedural terminology (CPT) codes in the newly released 2019 Medicare Physician Fee Schedule Final Rule. “AAOS strongly disagrees with the assumption that the seven high-volume CPT codes, including 27,130 (THA) and 27,447 (TKA), are potentially misvalued,” Dr. Halsey said. “Since they were last revalued by the Relative Value Scale Update Committee and CMS in 2013, there hasn’t been any evidence to suggest a change in physician work or practice expense.”

Read the AAOS press release…


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